Safe

All lines of enquiry related to this area of the CQC inspection are listed below. Visit the CQC website
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Click on one of the icons related to the Care Quality Commission inspection questions: is it safe, effective, caring, responsive or well-led. This will show the key lines of enquiry (KLOEs) associated with each question.

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S1.1 How are safeguarding systems, processes and practices developed, implemented and communicated to staff?

S1.2 How do systems, processes and practices protect people from abuse, neglect, harassment and breaches of their dignity and respect? How are these monitored and improved?

S1.3 How are people protected from discrimination, which might amount to abuse or cause psychological harm? This includes harassment and discrimination in relation to protected characteristics under the Equality Act.

S1.4 How are people supported to understand what keeping safe means, and how are they encouraged and empowered to raise any concerns they may have about this? If people are subject to safeguarding enquiries or an investigation, are they offered an advocate if appropriate or required?

Products that can help include...

Safeguarding Guide Safeguarding Guide

Strengthen your staff's understanding of safeguarding using Skills for Care's:

Safeguarding guidance - including what CQC inspectors look for and best practice record keepingSafeguarding route planner - tips for different approaches to embed safeguarding using practical resourcesSafeguarding induction and learning materials, including the Care Certificate and Learn from Others case studies

This guide identifies issues that commonly lead to safeguarding referrals from care homes, identifying the underlying causes. Prevention checklists help commissioners and providers work towards reduction in occurrences​​.

S2.1 What arrangements are there to manage risks appropriately, and to make sure that people are involved in decisions about any risks they may take?

S2.2 How do risk management policies and procedures minimise restrictions on people’s freedom, choice and control, in particular for people who lack mental capacity?

S2.3 Are people’s records accurate, complete, legible, up-to-date, securely stored and available to relevant staff so that they support people to stay safe?

S2.4 Are formal and informal methods used to share information with appropriate parties on risks to people’s care, treatment and support?

S2.5 Are there thorough, questioning and objective investigations into whistleblowing or staff concerns, safeguarding, and accidents or incidents? Are action plans developed, and are they monitored to make sure they are delivered?

S2.6 How is equipment, which is owned or used by the provider, managed to support people to stay safe? Relates to: All Services, How are the premises and safety of communal and personal spaces (such as bedrooms) and the living environment checked and managed to support people to stay safe? Relates to: Care homes?, How does the provider manage risks where they provide support in premises they are not responsible for? Relates to: All Services

S2.7 How do staff seek to understand, prevent and manage behaviour that the service finds challenging? How are individuals supported when their behaviour challenges? How well does this align with best practice?

Products that can help include...

Positive Behaviour Support Positive Behaviour Support

If you are supporting people with challenging behaviour you need well trained and competent staff. The guide Positive behavioural support (PBS): a mini guide to arranging and paying for training to support with PHBs, covers: ​what to look for in PBS training for staffhow to find a suitable learning provider paying for training​

By providing comprehensive policies and training on safe lone working, you will ensure your staff are less likely to experience a serious incident at work. Aimed at homecare and some community based services Skills for Care's lone working guide focuses on:

NICE quality standard on the prevention of falls and assessment after a fall in older people (aged 65 and over) who are living in the community or staying in hospital. It includes statements and measures on;

identifying people at risk of falling

risk assessment for older people at risk of falling

strength and balance training

home hazard assessment and interventions

The statements are specific and concise and focus on priorities for quality improvement. In particular, please see statements 1, 2 & 3.

NICE quality standard on preventing health problems associated with cold homes. It focuses on people particularly vulnerable to the effects of the cold, such as people with cardiovascular or mental health conditions and older people. It includes statements and measures on;

identifying people who are vulnerable to health problems associated with a cold home

asking them about keeping warm at home

The statements are specific and concise and focus on priorities for quality improvement.In particular, please see statements 1, 2, 3 & 4.

Violent and aggressive behaviours in people with mental health problems (2017) (QS154) Violent and aggressive behaviours in people with mental health problems (2017) (QS154)

NICE quality standard on short-term prevention and management of violent and physically threatening behaviour among adults, children and young people with a mental health problem. It includes statements and measures on;

Identifying triggers and warning signs

Prevening and managing violent and aggressive behaviour. In particular, please see statement 1.

QS163 Mental health of adults in contact with the criminal justice system (2018) QS163 Mental health of adults in contact with the criminal justice system (2018)

NICE quality standard on the recognition, assessment and management of mental health problems in adults (aged 18 and over) who are in contact with the criminal justice system. It includes statements and measures on:• responding to mental health problems• mental health assessment• sharing mental health care plans• risk management during transfersThe statements are specific and concise and focus on priorities for quality improvement. In particular, please see statement 3.

S3.1 What arrangements are there, including within the rotas, for making sure that staff have the right mix of skills, competencies, qualifications, experience and knowledge, to meet people’s individual needs?

S3.2 How is safety promoted in recruitment practices, arrangements to support staff, training arrangements, disciplinary procedures, and ongoing checks?

The people your service supports are more likely to receive personalised, responsive care, if you have recruited staff with the right values. The recruitment and retention section of our CQC providers guide covers:

This guide looks at practical ways in which you can safely recruit from a wider talent pool. It enables regulated services to implement safe and fair recruitment polices and practices, including when recruiting people with criminal convictions. Content includes;

Relates to: Services that administer medicines as part of providing regulated activity. Prompts that may be used by CQC inspectors to explore this...

S4.1 Is the service’s role in relation to medicines clearly defined and described in relevant policies, procedures and training? Is current and relevant professional guidance about the management of medicines followed?

S4.2 How does the service make sure that people receive their medicines (both prescribed and non-prescribed) as intended (including controlled drugs and ‘as required’ medicines), and that this is recorded appropriately?

S4.3 How are medicines ordered, transported, stored, and disposed of safely and securely in ways that meet current and relevant legislation and guidance?

S4.4 Are there clear procedures for giving medicines covertly, in line with the Mental Capacity Act 2005?

S4.5 How does the service make sure that people’s behaviour is not controlled by excessive or inappropriate use of medicines?

S4.6 How do staff assess the level of support a person needs to take their medicines safely, particularly where there are difficulties in communicating, when medicines are being administered covertly, and when undertaking risk enablement assessments designed to promote self-administration?

S4.7 How does the service engage with healthcare professionals in relation to reviews of medicines at appropriate intervals?

S4.8 How do staff make sure that accurate, up-to-date information about people’s medicines is available when people move between care settings? How do medicines remain available to people when they do so?

NICE quality standard on managing medicines in care homes. Residents should have the opportunity to make informed decisions about their care and treatment in partnership with health and social care professionals. Safeguarding and mental capacity issues are considered in relation to medicines.​​ In particular, please see statements 1, 2, 4, 5 & 6.

The guidelines covers good practice for managing medicines in care homes. It aims to promote the safe and effective use of medicines in care homes by advising on processes for handling and administering medicines. This includes recommendations on developing medicines policies, supporting residents to make informed decisions, sharing information, record-keeping, medicines related safeguarding, storing and disposing of medicines.

NICE quality standard in the management of Parkinson's disease in adults. It includes statements and measures on:• point of contact with specialist services•information about impulse control disorders• referral to physiotherapy, occupational therapy or speeach and language therapy• levodopa in hospital or a care homeThe statements in this standard are specifc and concise and focus on priorities for quality improvement. In particular, please see statement 4.

S5.1 What are the arrangements for making sure that premises are kept clean and hygienic so that people are protected from infections that could affect both staff and people using services? Relates to: All services responsible for premises, hygiene and cleanliness

S5.2 Do staff understand their roles and responsibilities in relation to infection control and hygiene?

S5.3 Are policies and procedures maintained and followed in line with current relevant national guidance?

S5. Where it is part of the service’s role to respond to and help to manage infections, how does the service make sure that it alerts the right external agencies to concerns that affect people’s health and wellbeing? Relates to: Services that respond to or manage infection

S5.5 Have all relevant staff completed food hygiene training and are correct procedures in place and followed wherever food is prepared and stored? Relates to: Services that provide, prepare or serve food as part of providing regulated activity, or that support people to do so for themselves

Products that can help include...

Care Certificate Care Certificate

Use Skills for Care's guidance, free workbooks and presentations to take new care workers through this standards. The following Care Certificate Standards relate to this:

Infection prevention and control (2014) (QS61) Infection prevention and control (2014) (QS61)

NICE quality standard on the prevention and control of infection for people receiving healthcare in primary, community and secondary care settings including the person’s own home, care homes and hospitals. It includes statements and measures on;

hand decontamination

insertion and removal of urinary catheters and vascular access devices

education about infection prevention and control.

The statements are specific and concise and focus on priorities for quality improvement.In particular, please see statements 2, 3, 4, 5 & 6.

S6.1 Do staff understand their responsibilities to raise concerns, to record safety incidents, concerns and near misses, and to report them internally and externally, where appropriate?

S6.2 What are the arrangements for reviewing and investigating safety and safeguarding incidents and events when things go wrong? Are all relevant staff, services, partner organisations and people who use services involved in reviews and investigations?

S6.3 How are lessons learned and themes identified, and is action taken as a result of reviews and investigations when things go wrong?

S6.4 How well is the learning from lessons shared to make sure that action is taken to improve safety across relevant parts of the service? Do staff learn from reviews and investigations by other services and organisations?

S6.5 How effective are the arrangements to respond to relevant external safety alerts, recalls, inquiries, investigations or reviews?

Please note that no specific resources have been developed by Skills for Care, NICE or SCIE relating to this specific part of the CQC inspection.

Learning from accidents and incidents (Good and outstanding care guide) Learning from accidents and incidents (Good and outstanding care guide)

Recommendations and practical examples from services rated good and outstanding including;

How to safely investigate and respond to accidents and incidents

How to avoid insufficient investigations and failure to use learning to inform improvements